Although the laws governing the Rwanda Social Security Board (RSSB) and Community Health Insurance are yet to be gazetted, officials at the board say the separation of healthcare provision from the collection of contributions will help improve operations of Mutuelle de Santé, a community based health insurance system covering most Rwandans.

Dr Daniel Ufitikirezi, the Chief Executive Officer of RSSB, says the Board is ready to coordinate the collection of contributions to the community health insurance called Mutuelle de Santé while the Ministry of Health will be in charge of running the healthcare provision for members of the scheme.

"There will no longer be agents at hospitals giving receipts to people who contribute to Mutuelle de Santé as it was the case previously,” Ufitikirezi told  The New Times in an interview.

The official said people will be depositing money in Savings and Credit Cooperatives (Saccos) and banks and that the RSSB will in turn ask the Rwanda Revenue Authority (RRA) to collect Mutuelle de Santé contributions on its behalf just like the authority collects pension contributions.

In the current management of the scheme, funds are collected by different individuals including the head of health insurance at district level, officials in charge of mobilisation for paying the contributions in sectors, and  officials placed at health centres in districts.

But, since 2012, subscriptions to the scheme have been going down leading to delays to pay health centres and hospitals.

Now officials at the RSSB say they will use the Board’s expertise to ensure that hospitals and pharmacies are paid on time, which will improve service delivery to patients covered by Mutuelle de Santé.

"We will be paying hospitals on time and as a result, hospitals will get medicine on time and give beneficiaries good services. Pharmacies will also be paid on time so they can get the right medicine,” Ufitikirezi said.

It is expected that Parliament will this month pass the new law governing Mutuelle de Santé, which also puts its management under the RSSB.

Observers say that improvement in the management of Mutuelle de Santé will attract subscribers to the scheme because what people want is access to good healthcare.

 "If the beneficiaries do not get decent treatment, they will lose interest in the scheme,” said Samuel Sembagare, the Mayor of Burera District, Northern Province.

An estimated 73 per cent of Rwandans used Mutuelle de Santé for their health insurance in the last fiscal year 2013/14, down from 80.7 per cent and 90.7 per cent in the financial years 2012/13 and 2011/12, respectively.

The Rwanda Social Security Board (RSSB) has also commissioned a study to investigate current deficiencies in Mutuelle de Santé and strategies to boost its performance.

Layoff very likely

Though he was not specific on how many people would lose their jobs following the restructuring, Ufitikirezi said a number of people are likely to lose jobs.

"The previous management of Mutuelle de Santé employed about 1,800 workers and we cannot retain all of them because in the synergies that will be constructed, there are positions that will no longer be necessary,” he said, adding that RSSB has branches in districts and that it will not be necessary to recruit the same number of workers.